IN-PATIENT PNEUMONIA BURDEN AND CASE FATALITY RATES IN CHILDREN OVER TWO DECADES IN FEDERAL TEACHING HOSPITAL, GOMBE (FTHG)

Introduction

Pneumonia is the leading cause of death among children globally accounting for an estimated 1.2 million (18%) total deaths annually. The number of childhood-related deaths from pneumonia is approximately 2000-fold higher in developing than in developed countries. Nigeria contributes the highest of pneumonia-related deaths globally.

Objectives

To determine the case fatality rates (CFR) of pneumonia from 2000-2019 in paediatric ward, FTHG.

Methodology

All cases of pneumonia admissions and deaths in patients aged 0-18 years, using ICD-10 classification, were retrieved and analysed. The mainstay of diagnosis is clinical and/or radiographic features.

Results

A total of 26,716 children were admitted during this period, 1151 had pneumonia (4.3%) and 118 died. Males constituted 647 (56.2%) and females 43.8% of the total pneumonia admissions. Children aged 0-5 years had the highest pneumonia admissions, followed by 6-9 years. Admissions were highest in the wet than the dry season. Pneumonia CFR was 10.2%; 10.9% in females and 9.7% in males. Under-5 constituted 84% (969/1151) of pneumonia admission with a CFR of 9.3%. CFR were 10.3% and 21% in 6-10 years, and 11-18 years respectively. The CFR between2000-2004 was 14.1%, 2005-2009:21.1%, 2010-2014:10.2% and 2015-2019:7.2%. Kanuri had the highest CFR of 56.2%.(P <0.05) Other ethnic groups were 29.4% in Waja, 25% in Tula, 21.4% in Igbo, 16.6% in Yoruba, 12.1% in Tangale, 10.2% in Hausa, 8.8%in Bolewa and 8.3% in Fulani. The CFR was highest in February20.2%.

Conclusion

Pneumonia Case fatality is high.

EPIDEMIOLOGIC TREND AND CASE FATALITY OF CHILDHOOD TETANUS IN FEDERAL TEACHING HOSPITAL GOMBE; A 20YEARS REVIEW

Introduction

Tetanus is a vaccine-preventable disease, it remains a significant cause of morbidity and mortality in both neonatal and post-neonatal periods, especially in developing countries with limited health facilities and inadequate vaccination. The overall case fatality rate (CFR) is 13.2% globally, highest in the neonatal period and in sub-Saharan Africa. CFR is 64%, 47%, and 43% in Nigeria, Uganda, and Tanzania respectively.

Objectives

To determine the Case Fatality Rate of Childhood tetanus in FTHG from 2000-2019.

Methodology

All cases and deaths from tetanus amongst children aged 0-18 years in paediatric medical ward of FTHG over the last two decades diagnosed clinically and classified using ICD-10 were analysed.

Results

95 cases of tetanus out of 26,716 total admissions constituting 0.004%. There were 49 tetanus deaths out of 3956 total childhood deaths (0.012%) over the study period. Males constituted 66% (63/95). 30% (28/95) were aged 0-28 days; 23.1% (22/95) were adolescents. Fulani and Hausa constituted 37% (34/95) and 31% (29/95) respectively. Admission was highest in the dry season 52% (50/95 %). The overall tetanus CFR was 51.6%; 78% of deaths were in males (38/49), 30% in neonates, and 23% in adolescents. CFR was highest during the dry season (67.3%). Hausa and Fulani had CFR of 51% and 40% respectively. P-value <0.05 The CFR was 88% between 2000-2004, 72% from 2005-2009, 71% between 2010-2014 and 33% from 2015-2019.

Conclusion

Tetanus CFR is still high among neonates and adolescents. Maternal tetanus vaccine and booster doses in children need strengthening.

REVEALING THE VARIED REALITY OF MALARIA-RELATED DEATHS IN CHILDREN ACROSS GENDER, AGE, AND ETHNICITY IN FEDERAL TEACHING HOSPITAL GOMBE OVER 20 YEARS: AN ESSENTIAL EPIDEMIOLOGIC IMPERATIVE

Introduction

Nigeria recorded 31% of 619,000 malaria deaths globally and accounts for 25-30% of all childhood mortality in the country. Few studies in Nigeria, have reported malaria's case fatality rate over a long period.

Objective

To determine Malaria Case Fatality Rate among Children admitted from 2000-2019.

Methodology

All severe malaria cases and deaths amongst children aged 0-18 over the last two decades were analysed using ICD-10. The diagnosis was based on clinical and microscopic findings.

Results

26,716 children were admitted, 2494 (9.3%) were diagnosed with malaria and 209 died. Malaria constituted 5.3% (209/3956) of all childhood mortality. Males constituted 58.9 % (1468/2494) while 65% (1642/2494) were aged 0-5 years. Of the malaria admissions, Fulani and Hausa constituted 948(38%) and 438(17.6%) respectively. Admissions were highest in October (15%) and in 2012 (9.6%). The overall malaria CFR was 8.3%; 8.8% in Females (91/1026) and 8.03% in Males P-value <0.05 (X2=54.735); 8.6% in children aged 0-5years, 8.2% in 6-10 years and 7.4% in 11-18 years, P-value <0.05 (X2=893.164). CFR was highest in April (11.4%)and lowest in November (5.2%). Kanuri and Igbo had CFR of 70% and 38.4% respectively while it was lowest in Tera tribe (4.3%), P-value<0.05. The CFR was highest in the year 2004 (22%), 3.5% in 2000 and 2006. Over the years, case fatality rate was 15.9% between 2000-2004, 6.1% from 2005-2009. Between 2010-2015, it was 7.3% and 8.5% from 2016-2019.

Conclusion

This study revealed the deadly reality of severe malaria with increased CFR among females, aged 0-5 and the Kanuri tribe.

CASE FATALITY RATE OF CHILDHOOD TUBERCULOSIS: EXPERIENCE FROM FEDERAL TEACHING HOSPITAL GOMBE: A TWO DECADE REVIEW

Introduction

Tuberculosis (TB) was the leading cause of death from an infectious agent worldwide, until the Coronavirus (COVID-19) pandemic, ranking above HIV/AIDS. Nigeria ranks 6th among the 30 TB high-burden countries (TB, TB/HIV, DRTB) and 1st in Africa. The estimated case fatality rate (CFR) of TB in Sub-Sahara Africa (SSA) is 15%.

Objective

To review the Tuberculosis case fatality rate (TCFR) in children diagnosed with TB from 2000-2019 in Federal Teaching Hospital Gombe.

Methodology

All cases of Tuberculosis (TB) diagnosed in children using ICD 10 classification were retrieved and analyzed. These included deaths from TB. The mainstay of TB diagnosis was clinical using TB Score (81%), Gene Xpert was 7%, and AFB was 10%.

Results

26,716 children were admitted; 383 had TB out of which 208(54.3%) were males and 175 (45.7%) females. TB constituted 1.4% of Paediatric admissions. Children 0 -5 years constituted 46.7% (179/383) of cases and 11 - 18 years were 31.3% (120/383). Fulani, Hausa, and Tangale constituted 43.6% (167), 21.1% (81), and 6.8% (26) of TB cases respectively. TB admissions were highest between 2015 and 2019 (31.8%). TB adenitis was the most common extrapulmonary TB. Tuberculosis/HIV co-infection accounted for 103(27%), out of which 74% (44) died. Overall TCFR was 15.6%; TCFR was 16.3% in males and 14.8% in females. The TCFR was 46.7% in 0-5yrs; 15% in 6-9yrs and 38.3% in 10-18yrs.Fulani had the highest CFR (11.9%). Tuberculosis CFR was highest between 2010-2014 (30.0%) and lowest in 2005-2009 (21.6%).

Conclusion

The Tuberculosis CFR is comparable to SSA CFR.

Oro-Naso-Sino-Orbital-Cutaneous Fistula From Prolonged Cocaine Use

Presentation We present the case of a 48-year-old man with nasal cellulitis and subsequent oro-naso-sino-orbital-cutaneous fistula from prolonged cocaine use. Diagnosis Initial laboratory investigations reported a raised white cell count (WBC) and C-Reactive Protein (CRP) and subsequently a positive atypical anti-neutrophil cytoplasm antibodies (ANCA) and positive anti-proteinase (PR3). Perihilar lung nodularity on chest imaging raised the possibility of a systemic autoimmune response. His urinalysis was positive for cocaine. Treatment He was commenced on Augmentin, Amphotericin B and Prednisolone. An obturator was created to manage the oro-nasal fistula. A subsequent naso-cutaneous defect was re-approximated. Daily nasal saline douche and abstinence of cocaine were recommended. Discussion Cocaine use in the community is rising and poses a challenge to multiple facets of our health care system.

Evaluation of the school supplementary feeding program in peninsular malaysia

This study was conducted to evaluate the implementation of the School Supplement Feeding Program (SSFP) among primary school in terms of financial management and budget disbursement, food preparation, selection of menus and nutrient content of food served. A total of 129 schools comprising 77 national type, 31 Chinese and 21 Tamil vernacular schools in four different regions (northern, eastern, central and southern) of Peninsular Malaysia were selected for this study. The results of this cross-sectional study showed a need to improve the budget disbursement to schools. Most of the schools followed the guidelines provided by the Ministry of Education for selection of eligible children. The quality of food prepared by contracted (local community members) and voluntary (teachers) operators. The use of 10 recommended menus provided for a 2-week cycle by most of the schools has shown increased acceptance and less monotonous feeling towards the food among the children. Nutrient content of food served increased relatively with an increase in budget from RM0.45 to RM0.80 per child. Parents surveyed indicated that the program should continue as this will keep children from low income families from being hungry during school hours. A continued process of monitoring and evaluation is necessary to improve its implementation.

Validation of a Dietary History Questionnaire against a 7-D Weighed Record for Estimating Nutrient Intake among Rural Elderly Malays

Energy and nutrient intake estimated using a pre-coded dietary history questionnaire (DHQ) was compared with results obtained from a 7-d weighed intake record (WI) in a group of 37 elderly Malays residing in rural areas of Mersing District, Johor, Malaysia to determine the validity of the DHQ. The DHQ consists of a pre-coded dietary history with a qualitative food frequency questionnaire which was developed to obtain information on food intake and usual dietary habits. The 7-d WI requires subjects to weigh each food immediately before eating and to weigh any leftovers. The medians of intake from the two methods were rather similar and varied by less than 30% for every nutrient, except for vitamin C (114%). For most of the nutrients, analysis of group means using the Wilcoxon matched pairs signed rank sum test showed no significant difference between the estimation of intake from the DHQ and from the WI, with the exceptions of vitamin C and niacin. The DHQ significantly overestimated the intake of vitamin C compared to the WI (p<0.05), whilst, the intake of niacin was significantly underestimated (p<0.05). The consistency of ranking as assessed using the Spearman's rank correlation coefficient (r) was satisfactory since there were positive correlations between all of the investigated nutrients estimated using the DHQ with those assessed using the WI, except for niacin. Furthermore, both the DHQ and the WI classified approximately 38 to 62% of the subjects into the same tertile for all nutrients, except vitamin C. Therefore, the DHQ was modified by adding a checklist of foods rich in vitamin C and niacin. In conclusion, the DHQ was fairly valid for obtaining the usual intake of most nutrients, particularly on a group basis. These findings indicate that in an elderly population with a high prevalence of illiteracy, a specially designed DHQ can provide very similar estimations to that obtained from 7-d WI.

Hepatitis C virus infection among dialysis patients in United arab emirates

To evaluate the incidence of positivity of anti-hepatitis C virus (anti-HCV) antibodies in the hemodialysis (HD) patients, and the impact of isolation of the anti-HCV positive patients, we studied 262 HD patients in our unit between January 1991 and December 1993. There were 64 patients with anti-HCV positivity. Forty nine of them were males, and 15 were females, with mean ages of 41.8 +/- 8.6 years. The mean dialysis period was 20.9 +/- 2.5 months. The serum anti-HCV antibodies were detected with second generation HCV enzyme linked immunosorbent assay. The test was repeated every three months for the patients, and every six months for the dialysis staff members. Dialyzers were not reused. Isolation of the positive patients by using designated HD machines was performed, besides adopting the universal precautions of infection. At the time of the inclusion to the study 45 patients out of 64 (70.3%) were anti-HCV positive. In this group 42% received blood transfusions, 17.5% started hemodialysis in another dialysis unit. Nineteen patients (29.7%) seroconverted during the study period. In this group, nine patients (47.6%) received blood transfusions (1.7 + 0.5 units). Of the seroconverted patients, eight (42%) travelled abroad and received HD during their holidays. Eight of the seroconverted patients did not have identifiable risk factors except HD. The overall seroconversion rate was 0.95 per 100 patient months. The rate decreased to 0.4 per 100 patient months if the identifiable causes for seroconversion (blood transfusion, duration of dialysis, holiday dialysis) were excluded. We conclude that HCV infection is frequent in hemodialysis patients. Strict follow up of the universal precautions together with isolation of anti-HCV positive patients with designated machines may be sufficient to prevent nosocomial transmission of HCV infection. The risk of transfusion may be minimized by using r-Human erythropoietin in the treatment of anemia in this population.

High-performance liquid chromatographic-mass spectrometric assay of high-value compounds for pharmaceutical use from plant cell tissue culture: Cinchona alkaloids

The use of high-performance liquid chromatography (HPLC) interfaced with thermospray (TSP) mass spectrometry is described for the separation and identification of various alkaloids from Cinchona ledgeriana extracts. The use of water-acetonitrile-acetic acid (71:25:4) with 0.01 M ammonium acetate (pH 3.0) as the mobile phase gave good HPLC separation and good TSP sensitivity. The specificity obtained by single-ion monitoring allowed the analysis of commercially important alkaloids such as quinine and quinidine in plant material, transformed roots and in cells from tissue culture, with relatively simple extraction and work-up procedures. TSP gave protonated species with few fragment ions but collision-induced dissociation offers the promise of increased analytically specificity from the fragment ion data. This work has important implications for the biotechnological production of pharmaceuticals normally obtained from plant sources.